Accuracy of combined clinical-mammographic-cytologic diagnosis of dominant breast masses. A prospective study
J. A. Butler, H. I. Vargas, N. Worthen and S. E. Wilson
Department of Surgery, Harbor-UCLA Medical Center, Torrance 90502.
Excisional biopsy is considered a mandatory part of the workup for patients
with dominant breast masses. To evaluate the efficacy of a combined
physical, mammographic, and fine-needle aspiration cytologic examination,
113 women were prospectively evaluated. Breast masses were listed as either
benign or suspicious/malignant. All patients underwent a subsequent biopsy.
Fifty-two (46%) of 113 patients had a malignant mass. The sensitivity and
specificity of the individual tests were as follows: 96% and 66% for the
physical examination; 94% and 73% for the mammographic examination; 90% and
93% for the fine-needle aspiration cytologic examination. For the 86
patients who underwent all three studies, the 25 patients with benign test
results on all three examinations had a benign pathologic result. One (6%)
of 18 patients with a single suspicious/malignant test result had cancer, 9
(64%) of 14 patients with two suspicious/malignant test results and 28
(97%) of 29 patients with three suspicious/malignant results also had
breast cancer. We conclude that the combined triad of physical,
mammographic, and fine-needle aspiration cytologic examinations is highly
accurate in the diagnosis of breast masses, and patients in whom all three
examination results are benign can be safely observed, obviating the need
for an open biopsy.
